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Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-1722. Epub 2015 Dec 24.

Population Outcomes of Three Approaches to Detection of Congenital Hearing Loss.

Author information

1
Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; The University of Melbourne, Parkville, Australia; melissa.wake@rch.org.au.
2
National Acoustic Laboratories, Australian Hearing, North Ryde, Australia; The HEARing Cooperative Research Centre, The University of Melbourne, Parkville, Australia;
3
Murdoch Childrens Research Institute, Parkville, Australia;
4
Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia;
5
Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; The University of Melbourne, Parkville, Australia;
6
Deakin Health Economics, Deakin University, Burwood, Australia; and.
7
Australian Hearing, Box Hill, Australia.
8
The University of Melbourne, Parkville, Australia;

Abstract

BACKGROUND:

Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost.

METHODS:

Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (>25 dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003-2005, n = 69; (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003-2005, n = 65; and (3) largely opportunistic detection, Victoria 1991-1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression.

RESULTS:

Children were diagnosed younger with universal than risk factor screening (adjusted mean difference -8.0 months, 95% confidence interval -12.3 to -3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P < .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P < .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P < .001); these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected.

CONCLUSIONS:

With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.

PMID:
26704085
PMCID:
PMC4702017
DOI:
10.1542/peds.2015-1722
[Indexed for MEDLINE]
Free PMC Article

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